Dyspnoea

An 83-year-old female with well-controlled mild persistent asthma on inhaled corticosteroids, presented with a complaint of worsening dyspnea for 3 weeks. Prior to presenting to the hospital, she was treated for bronchitis with oral antibiotics and a prednisone taper in an outpatient setting. However, her dyspnea continued to progress, requiring hospitalization.

Examination

Physical examination was notable for signs of volume overload including grade 2+ pedal edema and bilateral crackles on lung auscultation. Laboratory investigations were notable for leukocytosis of 15.5×109/L (normal range: 4.5 to 11.0×109/L), 26.7% eosinophils (normal range: 0–6%), BNP (brain natriuretic peptide) 1600 ng/L (normal <450 ng/L for patients 75–99 years old), troponin level 12 ng/mL (normal <0.4 ng/mL), serum creatinine 1.6 mg/dL (normal range 0.6–1.2 mg/dL), erythrocyte sedimentation rate 60 mm/hour (normal: 0–29 mm/hour), and C-reactive protein 5.13 mg/L (normal <3.0 mg/L). Electrocardiogram (ECG) showed non-specific ST-T wave changes. Computed tomography (CT) chest showed interstitial edema, and bilateral peripheral ground glass opacities with pleural effusions.